The concept of telemedicine in ophthalmology has been around ever since the telecommunications revolution in the early 90’s, but with modern technology, it is inconspicuously coming into its own.
On Day 4 of the ESCRS 2024, a session on the topic, chaired by Prof. Beatrice Cochener-Lamard (France) and Prof. Oliver Findl (Austria), delved into the rapidly evolving world of virtual eye care.
ESCRS luminary Prof. Mor Dickman (Netherlands) kicked off by breaking down the rapidly expanding jargon in the space, and he had only one purpose: to demystify telemedicine in ophthalmology.
Starting with the basics, Dr. Dickman explained, “Telemedicine is the use of medical information exchanged through electronic communication to improve patient health.”
Despite its promise, Dr. Dickman noted that telemedicine’s evidence base remains thin: “Burgeoning technology holds the potential to improve care and reduce costs, but research is needed to define where it truly enhances outcomes.”
COVID-19 accelerated the adoption of telemedicine globally, reshaping healthcare delivery. Dr. Dickman pointed out, “Telehealth, telemedicine, e-health, m-health… How do we make sense of these?” He clarified that telehealth is the broader term encompassing services beyond direct medical care, while telemedicine focuses on clinical services.
Dr. Dickman broke down the two types of telemedicine—synchronous, requiring real-time interaction between patient and provider—and asynchronous, like remote radiology, where care is provided at different times.
He shared examples of AI-driven telemedicine, particularly in cataract surgery follow-ups, emphasizing that “telemedicine has improved access to care and patient experience, but equity and efficiency implications—especially for rural and elderly populations—need further analysis.”
Dr. Dickman left the audience with a reality check: “Telemedicine is a tool, and like any other tool, it can be well used or misused.” The future of telemedicine depends on smart policies and sustainable financial incentives beyond the pandemic.
Vision for all: Can telemedicine level the playing field?
In his talk, Dr. Matthew Burton (United Kingdom) tackled the daunting issue of global eye health, reminding us just how vast the problem is. “As of 2020, 1.1 billion people were visually impaired,” he shared, with an alarming 43 million being completely blind. South Asia and Southeast Asia bore the brunt of these numbers, with over 90% of patients living in lower and middle-income countries.
Dr. Burton highlighted the key barriers to tackling this global issue: “Human resource gaps, reaching remote communities, and connecting people to services are some of the hurdles we must overcome.”
But he didn’t stop at problems—he also offered solutions. “We need innovative delivery methods, like teleophthalmology, m-health solutions, and AI-assisted services,” Dr. Burton added, pointing to promising projects already making an impact.
Examples included reaching the “last mile” of cataract patients in Nigeria, teleophthalmology projects in India, and m-health solutions in Kenya and Pakistan. Dr. Burton also spotlighted the RAAB (Rapid Assessment of Avoidable Blindness) project, noting, “RAAB uses m-health to collect crucial data for regional and global planning.”
However, implementing these innovations isn’t without its challenges. “Telecommunication constraints, equipment costs and the availability of trained personnel are all hurdles,” Dr. Burton acknowledged. Yet, despite the difficulties, his presentation was a rallying call for continued innovation and persistence in the fight for global eye health.
What telemedicine can—and can’t—do
Next, Dr Danson V. Muttuvelu (Denmark) delivered a presentation on the potential—and limitations—of teleophthalmology for posterior segment care. With Europe’s aging population as the backdrop, Dr. Muttuvelu emphasized the need to rethink healthcare delivery. “Demographic shifts mean there are opportunities to rethink how care is delivered,” he stated.
Dr. Muttuvelu shared his experiences from Moorfields Eye Hospital (United Kingdom), where virtual clinics have shown promise. “Virtual clinics work well for stable and advanced AMD patients, retinopathy follow-ups and stable retinal vein occlusion cases,” he explained.
The benefits are clear: Improved patient safety, increased capacity and high patient satisfaction with shorter visits. Plus, they offer more flexibility for ophthalmologists.
However, scaling this innovation isn’t as simple as downloading an app. “Challenges include lack of access to data, required infrastructure and a leadership culture to support this innovation,” Dr. Muttuvelu said. He also highlighted the need for an integrated IT platform that connects different care providers, from optometrists to ophthalmologists.
On the bright side, telemedicine can improve referral accuracy. A collaboration with Specsavers in Denmark revealed that only 19% of patients seen by opticians required specialist care.
“Tele-ophthalmology is cost-effective and can streamline the referral process,” Dr. Muttuvelu added. After screening 1.1 million people over five years, less than 1% were referred back to the Danish healthcare system—a testament to its efficiency.
While teleophthalmology in the current technological environment holds great promise, the path to widespread adoption still has some blind spots.
Zooming in: Teleophthalmology’s role in anterior segment
Dr. Sunil Mamtora (United Kingdom) brought refreshing clarity to the hot topic of teleophthalmology for anterior segment care.
“Let’s talk about the technical challenges, the solutions we’ve provided and the lessons we’ve learned,” Dr. Mamtora began, diving into how telemedicine is reshaping eye care.
Teleophthalmology is making strides in anterior segment imaging, especially in keratoconus follow-up, corneal graft monitoring and cataract pre-assessment. Dr. Mamtora highlighted its current uses, noting, “Today, it’s used in keratoconus follow-up, stable corneal graft follow-up and cataract pre-assessment.”
The low-hanging fruit? Slit lamp imaging technology, which Dr. Mamtora believes can revolutionize access to expertise and patient care. “From a global perspective, slit lamp imaging technology can facilitate access to expertise and patient care,” he explained.
He also pointed out how rapidly advancing camera sensor technology is enhancing these capabilities. “Considerable advances in camera sensor technology in the last four years continue to improve,” he said. And while single images are helpful, he added, “Slit lamp videos may be more useful than just a snapshot.”
In the bigger picture, teleophthalmology is a tool for democratizing access to specialist care, potentially leveling the playing field in ophthalmic training. “There’s a paradigm shift in how we deliver care, and technology is at the heart of it,” Dr. Mamtora concluded with optimism for the future of teleophthalmology.
Teleophthalmology 2.0: How AI is enhancing eye care, not replacing it
Dr. Mostafa El Habib Daho (France) took his turn at the podium to highlight the transformative potential of AI in teleophthalmology. “AI in teleophthalmology is reshaping how we deliver eye care, leading to improved accuracy, efficiency and personalized outcomes,” Dr. Daho stated, setting the tone for his insightful presentation.
He discussed several AI-driven solutions that are already making waves in the field, particularly in the automatic screening of diabetic retinopathy, glaucoma and dry eye.
“Today, there are several commercialized solutions that integrate AI to aid in the automatic screening of these conditions,” he explained, emphasizing the rapid adoption of technology.
Looking ahead, Dr. Daho outlined the key challenges the field will face. “As we prepare for the future of AI in telemedicine, we need to consider regulatory and policy issues, ethical considerations, technology infrastructure, staff training and patient education,” he noted.
In closing, Dr. Daho reassured his audience that AI, while powerful, is not here to replace ophthalmologists. “AI can screen, perform as well as experts, conduct multimodal analyses and support patient follow-up, but it remains an added value for teleophthalmology—not a replacement for doctors,” he concluded.
Saving the planet, one virtual visit at a time
Dr. Afsun Sahin (Turkey) presented a compelling case in conclusion for the environmental and financial benefits of teleophthalmology, highlighting how this technology can revolutionize eye care while saving both the planet and patients’ wallets.
“With telemedicine, there is a significant reduction in carbon footprint as fewer patients travel for in-person appointments,” Dr. Sahin pointed out, emphasizing the environmental impact.
He referenced a systematic review by Arthur Hebbie, et al.1, which found that switching to telemedicine could save between 0.7 and 372 kg of CO2 per consultation, depending on the context.
On the financial side, Dr. Sahin noted, “Patients no longer need to travel long distances for eye care appointments, leading to substantial savings on fuel, parking fees, and public transport costs.” A study he cited estimated that telemedicine in eye care could save $1.1 million in patient transportation costs.
Beyond patient savings, telemedicine also reduces the need for extensive clinic space, cutting down on energy consumption for lighting, heating, and cooling.
“While there may be high initial investments, the long-term financial benefits for both patients and providers are clear,” Dr. Sahin concluded. He also highlighted the role of AI in enhancing efficiency, though he cautioned that it requires careful energy management to maintain sustainability.
Teleophthalmology, it seems, is not just good for your eyes—it’s good for the planet too.
Editor’s Note: Reporting for this story took place at the 42nd Congress of the European Society of Cataract and Refractive Surgery (ESCRS 2024), held from 6-10 September in Barcelona, Spain.
Reference
- Purohit A, Smith J, Hibble A. Does telemedicine reduce the carbon footprint of healthcare? A systematic review. Future Healthc J. 2021;8(1):e85-e91.
